Clinical Presentation and Outcomes of Patients With Cancer-Associated Isolated Distal Deep Vein Thrombosis
Authors: Jean-Philippe Galanaud, Javier Trujillo-Santos, Behnood Bikdeli, Laurent Bertoletti, Pierpaolo Di Micco, Géraldine Poénou, Conxita Falgá, Marija Zdraveska, Jorge Lima, Francisco Rivera-Civico, Josefa Fernández Muixi, Manuel Monreal, María Dolores Adarraga, Ana Alberich-Conesa, Paloma Agudo, Jesús Aibar, Joaquín Alfonso, Cristina Amado, Soraia Amorós, María Angelina-García, Juan Ignacio Arcelus, Aitor Ballaz, Raquel Barba, Cristina Barbagelata, Manuel Barrón, Belén Barrón-Andrés, José Bascuñana, Fahd Beddar-Chaib, Ángeles Blanco-Molina, Ernesto Botella, Leyre Chasco, Pau Cerdà, Juan Criado, Jorge del Toro, Cristina De Ancos, Pablo Demelo-Rodríguez, Cristina De Juana-Izquierdo, Ana María Díaz-Brasero, María del Carmen Díaz-Pedroche, José Antonio Díaz-Peromingo, Álvaro Dubois-Silva, José Carlos Escribano, Francis Espósito, Conxita Falgá, Ana Isabel Farfán-Sedano, Cloefe Fernández-Aracil, Carmen Fernández-Capitán, Begoña Fernández-Jiménez, Josefa Fernández-Muixi, José Luis Fernández-Reyes, Carme Font, Iria Francisco, Cristina Gabara, Marta García de Herreros, Ferrán García-Bragado, Alberto García-Ortega, Olga Gavín-Sebastián, María Gil-De Gómez, Aída Gil-Díaz, Covadonga Gómez-Cuervo, José González-Martínez, Enric Grau, Leticia Guirado, Javier Gutiérrez, Luis Hernández-Blasco, María Jesús Jaras, David Jiménez, Inés Jou, María Dolores Joya, Marta Olimpia Lago-Rodríguez, Sara Lainez-Justo, Ana Latorre-Díez, Ramón Lecumberri, José Manuel León-Ramírez, Jorge Lima, José Luis Lobo, Meritxell López-De la Fuente, Luciano López-Jiménez, Patricia López-Miguel, Juan José López-Núñez, Raquel López-Reyes, Antonio López-Ruiz, Juan Bosco López-Sáez, Manuel Alejandro Lorente, Alicia Lorenzo, Marina Lumbierres, Olga Madridano, Ana Maestre, Laia Mas-Maresma, María Marcos, Javier Miguel Martín-Guerra, Francisco Martín-Martos, Iván Martínez-Redondo, Meritxell Mellado, Elisabeth Mena, María Isabel Mercado, Jorge Moisés, Manuel Monreal, Arturo Muñoz-Blanco, Gema Muñoz-Gamito, María Sierra Navas, José Antonio Nieto, Elisabeth Noguera-Gras, Manuel Jesús Núñez-Fernández, Mónica Olid-Velilla, Lucia Ordieres-Ortega, María Ortiz, Jeisson Osorio, Sonia Otálora, Nazaret Pacheco-Gómez, Diana Paredes-Ruiz, Pedro Parra, José María Pedrajas, Cristina Pérez-Ductor, María Luisa Peris, María Lourdes Pesce, José Antonio Porras, Javier Poyo-Molina, Ramón Puchades, Antoni Riera-Mestre, Francisco Rivera-Civico, Alberto Rivera-Gallego, Mireia Roca, Vladimir Rosa, Ana Rodríguez-Cobo, Consolación Rodríguez-Matute, Carmen María Rubio, Pedro Ruiz-Artacho, Nuria Ruiz-Giménez, Justo Ruiz-Ruiz, Giorgina Salgueiro, Teresa Sancho, Vanesa Sendín, Patricia Sigüenza, Silvia Soler, Beatriz Suárez-Rodríguez, José María Suriñach, Raimundo Tirado, Carles Tolosa, María Isabel Torres, Javier Trujillo-Santos, Fernando Uresandi, Reina Valle, José Felipe Varona, Gema Vidal, Paula Villares, Cihan Ay, Stephan Nopp, Ingrid Pabinger, Caroline Martens, Thomas Vanassche, Peter Verhamme, Hugo Hyung Bok Yoo, Jesús David Arguello, Ana Cristina Montenegro, Jairo Roa, Jana Hirmerova, Radovan Malý, Sandrine Accassat, Laurent Bertoletti, Alessandra Bura-Riviere, Judith Catella, Romain Chopard, Francis Couturaud, Oliver Espitia, Claire Grange, Barbara Leclercq, Raphael Le Mao, Isabelle Mahé, Farés Moustafa, Ludovic Plaisance, Géraldine Poenou, Gabrielle Sarlon-Bartoli, Pierre Suchon, Edouard Versini, Sebastian Schellong, Benjamin Brenner, Najib Dally, Inna Tzoran, Raheleh Kaviani, Jamal Moosavi, Parham Sadeghipour, Manuela Basaglia, Franca Bilora, Cristiano Bortoluzzi, Barbara Brandolin, Mauricio Ciammaichella, Donatella Colaizzo, Francesco Dentali F, Pierpaolo Di Micco, Matteo Giorgi-Pierfranceschi, Elvira Grandone, Egidio Imbalzano, Simona Merla, Raffaele Pesavento, Paolo Prandoni, Paolo Scarinzi, Carmine Siniscalchi, Beldisa Taflaj, Antonella Tufano, Adriana Visonà, Ngoc Vo Hong, Beniamino Zalunardo, Dana Kigitovica, Rolands Paluga, Andris Skride, Samuel Fonseca, Micaela Manuel, Jose Meireles, Sara Pinto, Marijan Bosevski, Emilija Lazarova, Marija Zdraveska, Henri Bounameaux, Lucia Mazzolai, Joseph A. Caprini, Ido Weinberg, Hanh My Bui
Journal: Journal of Clinical Oncology (2023)

PURPOSE Patients with isolated distal deep vein thrombosis (DVT) have lower rates of adverse outcomes (death, venous thromboembolism [VTE] recurrence or major bleeding) than those with proximal DVT. It is uncertain if such findings are also observed in patients with cancer. METHODS Using data from the international Registro Informatizado de la Enfermedad TromboEmbolica venosa registry, we compared the risks of adverse outcomes at 90 days (adjusted odds ratio [aOR]; 95% CI) and 1 year (adjusted hazard ratio [aHR; 95% CI]) in 886 patients with cancer-associated distal DVT versus 5,196 patients with cancer-associated proximal DVT and 5,974 patients with non–cancer-associated distal DVT. RESULTS More than 90% of patients in each group were treated with anticoagulants for at least 90 days. At 90 days, the adjusted risks of death, VTE recurrence, or major bleeding were lower in patients with non–cancer-associated distal DVT than in patients with cancer-associated distal DVT (reference): aOR = 0.16 (0.11-0.22), aOR = 0.34 (0.22-0.54), and aOR = 0.47 (0.27-0.80), respectively. The results were similar at 1-year follow-up: aHR = 0.12 (0.09-0.15), aHR = 0.39 (0.28-0.55), and aHR = 0.51 (0.32-0.82), respectively. Risks of death, VTE recurrence, and major bleeding were not statistically different between patients with cancer-associated proximal versus distal DVT, both at 90 days: aOR = 1.11 (0.91-1.36), aOR = 1.10 (0.76-1.62), and aOR = 1.18 (0.76-1.83), respectively, and 1 year: aHR = 1.01 (0.89-1.15), aHR = 1.02 (0.76-1.35), and aHR = 1.10 (0.76-1.61), respectively. However, more patients with cancer-associated proximal DVT, compared with cancer-associated distal DVT, developed fatal pulmonary embolism (PE) during follow-up: The risk difference was 0.40% (95% CI, 0.23 to 0.58). CONCLUSION Cancer-associated distal DVT has serious and relatively comparable outcomes compared with cancer-associated proximal DVT. The lower risk of fatal PE from cancer-associated distal DVT needs further investigation.